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Framework was then compared to ethics model of informed consent with key domains of:

Voluntariness

Capacity

Disclosure

Comprehension

Consent

Consensus frameworks developed through group discussion closely approximated the established models for both delivering bad news and obtaining meaningful informed consent.

3. Simulated Patient Experience:

Case involving new diagnosis of breast cancer was developed in consultation with Dept. of Surgery faculty.

Role for simulated patient was developed in consultation with Dept. of Surgery and the Simulation Center.

Checklists of appropriate skills when delivering bad news and obtaining informed consentwere distributed to interns to be used while observing simulated patient interactions. Checklists were compared to the consensus frameworks created by the interns.

Case: 33 year old single mother with family history of lung cancer and a new diagnosis of stage 1 ductal carcinoma of the breast. Initially noted on self breast exam; confirmed by mammography. Biopsy occurred 2 weeks ago. Options for surgery include radical mastectomy or lumpectomy with radiation.

2 simulated patient scenarios:

Intern charged with delivering news of diagnosis and establishing strategy for moving forward.

Intern charged with obtaining meaningful informed consent based on patient’s preferences regarding surgical approach.Options for radical mastectomy vs. lumpectomy with radiation were understood to be equivalent with respect to survival.

Each lab session included 2 performances of each scenario. While one intern interacted with the simulated patient, colleagues observed and evaluated the interaction based on the observation checklists.

4. Feedback:

After simulated patient encounter, intern in role play reflected on experience with group and ethics faculty to reinforce teaching points.

Constructive criticism was offered by colleagues based on observation guide.

Simulated patient offered specific feedback to interns based on each encounter.

METHODS

Setting: Department of Surgery devoted a set of ongoing surgical skills training lab sessions to ethics skills development for interns.